Exploring the availability and accessibility of menstrual friendly public toilets (MFPTs) in urban spaces: A global multi-city audit study

Background: Public toilets enable populations, including those who menstruate, to move through public spaces. Menstrual Friendly Public Toilets (MFPT) are accessible, safe, and clean public toilets that provide those who menstruate the space and resources to navigate cities with dignity and comfort. However, there is little evidence on the status of MFPTs in urban centers. This study assessed the menstrual friendly characteristics of public toilets in Barcelona, Kampala, Manila, New York City, Osaka, Rio de Janeiro and quantified the overall "menstrual friendliness" by city and neighborhood type. Methods: We conducted public toilet audits in four types of neighborhoods (Business, Tourist, Transit hub, Residential) in each city. The audit tool captured a range of menstrual health and hygiene (MHH) characteristics. Aggregate scores ("MFPT Index") were calculated to summarize the menstrual friendliness of public toilets within the neighborhoods and across cities. Results: A total of 181 public toilet audits were analyzed. Areas around Transit hubs had the highest density of toilets, Residential areas were comparatively under resourced, and toilets in Business areas were relatively more "menstrual friendly." The overall mean score for the MFPT Index was 0.67, ranging between 0.49 and 0.79 across cities. Sub-domain scores of the MFPT Index indicated key aspects for improvement in relation to Accessibility, Structure, Privacy/Safety, General Resources, Cleanliness, and MHH Resources. Conclusion: There is a significant gap in the provision of MFPTs in urban centers. Further research is needed to understand the extent of challenges related to accessibility, structural amenities, and availability of MHH-related resources, and how they can best be addressed. Our study's findings underscore the need for the prioritization of MFPTs in public spaces to ensure all individuals have equitable access to manage their menstrual cycles.